CC Nov 2016 Schizophrenia

echoecho's version from 2016-12-11 23:18


Question Answer
Define?"Split mind" in Greek. Chronic psychotic disorder characterized by impairments in social and occupational functioning
What is the global prevalence? Ethnicities? Gender more common in?1) between 0.3% and 0.7%. 2) found in all ethnicities. 3) slightly more common in men
In the US, schizophrenia is diagnosed disproportionately in what ethnicity, possibly representing ethnic bias?AA
It typically occurs in what part of lif in males? In women?1) young adulthood 2) young adulthood or early middle age
Is there a genetic predisposition and what genes are involved?1) yes. 2) unknown genes
Schizophrenia in a first degree relative increases the patient's risk for others psychiatric disorders, list these?1) schizoaffective disorder 2) schizotypal personality disorder 3) bipolar disorder 4) major depressive disorder 5) autism spectrum disoeder
Symptoms are classified in what 2 categories, and give examples of each?1) positive (hallucinations, delusions, disorganized speech)2) negative (decreased emotional expression, withdrawal, loss of interest in school or work)
Early symptoms of schizophrenia may be confused with what other psychiatric conditions?1) major depression 2) bipolar disorder
List th six DMS-5 criteria for schizophrenia?(A)two or more of the following, each present for a significant portion of time during a 1 month period. At least one of these must be item 1,2,3 in the list following {(1) delusions (2) hallucinations (3)disorganized speech such as frequent derailment or incoherence (4)grossly disorganized or catatonic behavior (5)negative symptoms B) for a significant portion of time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self care is markedly below the level achieved prior to the onset, or, when onset is in childhood or adolescence, failure to attain an expected level of achievement or function C. Continuous signs of disturbance persist for at least 6 months. D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out E. The disturbance is not attirbutable to the pshysiological effects of w substance or medical condition. F) if there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional dx of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month (or less if successfully treated)
Using these criteria, a patient suspected of having schizophrenia should have the what evaluation prior to making the diagnosis?A) Exclusion of medical conditions that could mimic psychotic symptoms but are differentiated based on physical and lab findings. These conditions include = a) brain tumor (focal neurologica signs, abnormal brain imaging), b) Cushing syndrome (physical findings of corticosteroid excess, elevated serum cortisol, buffalo hump), c) dementia (cognitive deficits, abnormal mini mental state exam), d) infection (delirium, fever, localizing infection signs, elevated white cell count), e) SLE (physical findings, anemia, antinuclear antibodies), f) temporal lobe epilepsy (abnormal electroencephalogram), g) thyroid disorder (physical findings of hyper /hypothyroidism, abnormal thyroid stimulating hormone), h) vitamin B12 deficiency (memory impairment, glosjsitie, low serum B12). B) exclusion of substances that could mimic psychotic symptoms (including alcohol and illegal drugs), C) Exclusion of mood disorders with psychotic features
What is the cornerstone of medical therapy?antipsychotic medication
It is stated that stimulation of _____activity causes of worsens psychotic behaviors?D2 (dopamine)
Antipsychotic medications are D2 receptor antagonists; higher levels of receptor affinity are associated with side effects such as what?hyperorikactinemia, akathisia (agitation and restlessness), extrapyramidal symptoms.
Antipsychotics are classified into two categories, name these?1) typical (first generation) 2) atypical (second generation)
Both antipsychotic classes are equally effective but differ in what?their side effect profiles
Typical antipsychotics are primarily _______ antagonists?D2
How do the typical antipsychotics differ from the atypical psychotics?typical antipsychotics are largely effective for the positive symptoms of schizophrenia but are associated with a more hyperorikactinemia and EPS than the atypical antipsychotics.
List examples of typical antipsychotics?1) haloperidol (Haldol). 2) thioridazine (Melarill). 3) chlorpromazine (Thorazine)
Atypical antipsychotics antagonize both ____ receptors and _____ receptors?D2; serotonin
Because atypical antipsychotics antagonize two receptors, what is the advantages and disadvantages?1)reduction in the incidence of extrapyramidal symptoms and an improved treatment of negative symptoms 2) increased incidence of metabolic symptoms (weight gain, insulin resistance, glucose intolerance, elevated levels of C-relative protein, dyelipidemiw (elevated triglycerides, elevated LDL, and decreased HDL)
Effect of atypical antipsychotics on weight gain/ diabetes and dyslipidemia?1) Aripiprazole (Abilify)(+1, (-) 2) Clozapine (Clozaril)(4+, 4+) 3) Olanzapine (Zyprexa) (4+, 4+) 4) Quetiapine (Seroquel)(3+,3+) 5) Risperidone (Risperdal)(3+, 1+). 6) Ziprasidone (Geodon) (1+, (-)
Clozapine (Clozaril) is also associated with a risk of what?agranulocytosis
Due to its high efficacy, which antitypical can be the initial medications selected, with a switch to w medication with a better adverse reaction effect profile once psychiatric stabilization is attained?Olanzapine (Zyprexa)
QT prolongation can occur in both typical and atypical antipsychotics, including what one typical and two atypicals? Which one is these three is there insignificant prolongation?1) thioridazine (typical); Ziprasidone (atypical); Quetiapine (atypical) 2) Aripipraxole
Is there increased incidence of cardiac morbidity or mortality directly detected due to QT prolongation? Caution should be used for what patient?1) no 2) those with inherent or acquired QT prolongation
Does treatment of co-morbid mood disorders improve the mood symptoms? Does it help the symptoms of schizophrenia?no; no
*** The risk of suicide is significantly higher in patients with shiczophrenia, particularly those patients with what symptoms?auditory hallucinations, delusions, substance abuse of a previous suicide attempt
*** Patirnts newly diagnosed with schizophrenia require what evaluation?urgent psychiatric evaluation
What type of treatment approach is recommended?a multidisciplinary approach with medication, social support and psychological treatment
*** What therapy is the most commonly recommended form of psychotherapy, but there is no strong evidence that it is superior to other forms of talk therapy?CBT (cognitive behavioral therapy)
What therapy is used as adjunctive treatment with medication?CBT
Remission of schizophrenia is defined as what?at least 6 months of no symptoms of mild symptoms that do not interfere with daily activities
Describe the course of schizophrenia?is varied and may include exacerbations and remissions or chronic persistent disease
Treatment responses vary and outcomes are difficulty to predict, although individuals who respond to medication within the first ___ weeks are more likely to have a response long term?4
Maintenance therapy for at least ____ to _____ years is recommended for those responding to medication therapy? Why?1 to 2 years; because if the high risk of relapse with discontinuation
It is estimated that ___ to ____% of individuals will have a positive outcome (mild impairment or recovery)?20-50%
Most individuals will need continued ______, but with the help of medication, will be able to live independently?support
The overall mortality for patients with schizophrenia is also higher due to what?a higher incidence of cardiovascular disease, can't and thromboembolic events
*** SUMMARY= Schizophrenia typically presents in young adulthood in what gender and in young adulthood of early middle age in what gender?men; women
*** SUMMARY = The cornerstone of medical therapy is what type of medications? Both classes are equally effective but differ in what profile?1) antipsychotic medications (typical and atypical) 2) differ in side effect
*** SUMMARY = Describe the course if patients diagnosed with schizophrenia?varied and may include exacerbations and remissions of chronic persistent disease
*** SUMMARY = The overall mortality for patients with schizophrenia is higher due to what higher incidence?higher incidence of cardiovascular disease, cancer and thromboembolic events